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CMS names 89 new Medicare accountable care organizations serving beneficiaries in 40 states and the District of Columbia as of July 1 Print E-mail
Written by Jeffrey Herschler   
Friday, 27 July 2012 10:17

Below is a list of the new Florida ACOs:

Accountable Care Coalition of Northwest Florida, LLC, located in Pensacola, Florida, is comprised of networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in Alabama and Florida.

Accountable Care Partners, LLC, located in Jacksonville, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 65 physicians. It will serve Medicare beneficiaries in Florida and Georgia.

Allcare Options, LLC, located in Parrish, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 198 physicians. It will serve Medicare beneficiaries in Florida.

Florida Medical Clinic ACO, LLC, located in Zephyrhills, Florida, is comprised of networks of individual ACO practices, with 153 physicians. It will serve Medicare beneficiaries in Florida.

FPG Healthcare, LLC, located in Orlando, Florida, is comprised of ACO group practices, with 142 physicians. It will serve Medicare beneficiaries in Florida.

HealthNet LLC, located in Boynton Beach, Florida, is comprised of networks of individual ACO practices, with 55 physicians. It will serve Medicare beneficiaries in Florida.

Integrated Care Alliance, LLC, located in Gainesville, Florida, is comprised of networks of individual ACO practices, with 115 physicians. It will serve Medicare beneficiaries in Florida.

Medical Practitioners for Affordable Care, LLC, located in Melbourne, Florida, is comprised of networks of individual ACO practices, with 126 physicians. It will serve Medicare beneficiaries in Florida.

Palm Beach Accountable Care Organization, LLC, located in West Palm Beach, Florida, is comprised of networks of individual ACO practices, with 337 physicians. It will serve Medicare beneficiaries in Florida.

Reliance Healthcare Management Solutions, LLC, located in Tampa, Florida, is comprised of networks of individual ACO practices, with 36 physicians. It will serve Medicare beneficiaries in Florida.
 
New State Laws Affect Docs and other Healthcare Pro's Charged in Criminal Matters Print E-mail
Written by Elizabeth Perez   
Friday, 27 July 2012 10:13

The war on health care fraud continues to be front and center in Florida. Effective as of July 1, 2012, laws enacted this legislative session amend the draconian licensure penalties (enacted in 2009) for health care professionals who are convicted of certain criminal charges. Currently, licensing boards within the Department of Health must refuse to issue or renew the license of health care professionals if they have been convicted of certain enumerated crimes within 15 years from the date of application. This change relaxes this penalty, but expands the reach of the criminal convictions to similar laws in other jurisdictions.

Click HERE to read the entire article.

Elizabeth Perez is Of Counsel in the Fort Lauderdale office of the statewide law firm Broad and Cassel. A health law attorney, she is a member of the firm's Commercial Litigation, Health Law and White Collar Criminal and Civil Fraud Defense Practice Groups. She may be reached at (954) 764-7060 or epperez@broadandcassel.com.
Last Updated on Friday, 10 August 2012 10:28
 
Saving the Medicaid Expansion Print E-mail
Written by Paul Gionfriddo   
Sunday, 22 July 2012 10:13

Our Health Policy Matters        
 

A column focusing on federal, state and local health policy  

Within days of the Supreme Court's ACA ruling that made the Medicaid expansion optional, the governors of Florida, South Carolina, Iowa, and Louisiana all announced that they wanted to opt out of it

The governors of six other states were considering the same thing.

However they frame their views for the media, they are in fact an attack on two different constituencies.  The first is lower income uninsured families, elders, and single adults, 17 million of whom expected to become insured as a result of the expansion.  The second is safety net providers - nursing homes, hospitals, community health centers, mental health facilities, and others - who need Medicaid dollars to offset the costs of caring for people who have no insurance.

But there could be a very simple way for the federal government to save the Medicaid expansion in those states - and the Supreme Court hinted at it in its majority decision two weeks ago.  This week's Our Health Policy Matters column, Saving the ACA Medicaid Expansion, explains how. 

Click HERE to read the entire blog post.

Last Updated on Sunday, 22 July 2012 10:15
 
Enjoying the Ride? Print E-mail
Written by Jeffrey Herschler   
Friday, 20 July 2012 08:10

   roller coaster
Med Mal Roller Coaster

The cyclical nature of the medical malpractice insurance industry is well documented. Check out this excerpt from the digital archive at CBS Life & Health Library, just nine years ago, when we were on the other end of the wave:

"Medical malpractice claims have held steady, yet insurance premiums have skyrocketed. This pattern can be attributed to the cyclical nature of the commercial insurance business. We are in the midst of a classic hard insurance cycle. The first such crisis, which was particularly acute in the product liability and medical liability sectors, occurred in the mid-'70s. The second crisis, dramatically detailed in the 1986 Time magazine cover story entitled Sorry, Your Policy Is Cancelled was more..."(click HERE to read more of the 2003 story).

According to Matt Gracey, President of Danna-Gracey, a medical malpractice brokerage firm with offices in Delray Beach and Orlando, the current soft market in medical malpractice is characterized by the following:
  • Low rates: Up to 60% lower than 2005;
  • More choices of insurers; much more competitive climate due to the favorable claims cycle;
  • Loose underwriting; claims are more often overlooked by insurers.  
  • Expanded coverage; lots of bells and whistles on standard policies!
Sounds good! Let the good time roll, right? Not so fast, says Gracey. With a hard market ahead, it makes sense to get ready for the inevitable. And the market might be turning sooner rather than later. 

There are already some ominous signs. For example:
  • Loss ratios are increasing as pricing decreases; many insurers are over or approaching a "combined loss ratio" of over 100%. 
  • Reserve takedowns dwindling; insurers have been using claims reserves to bolster their losses, thus allowing them to keep their pricing as low as possible.   
  • Market shrinking as doctors retire, sell out to hospitals, or go bare.
Meanwhile the 2003 Tort Reform law is being challenged in Florida's Supreme Court and there are serious concerns that the law will be struck down. But they are working on Tort Reform at the national level (see House proposal would reform medical liability), so why worry? Says Gracey, "For years the House has passes great versions of Tort Reform, which all fail to get the 60 votes needed in the Senate. This one will go the same way. This is just election year posturing to show doctors that Republicans are trying and it's the Democrats' fault."

To get ready for the next medical malpractice storm, Gracey recommends the following:
  • Move to high ground! Insure with highly rated, financially solid companies that have a track record of being committed to Florida's doctors in more difficult market conditions. 
  • Plan now to avoid being uninsurable, or not able to afford coverage;
  • Examine coverage options; get an independent expert to review your coverage for gaps. 
  • Examine bare options and reexamine your asset protection plan. 
In closing, Gracey has one last piece of advice: "Enjoy the party while it lasts!"

Last Updated on Friday, 27 July 2012 10:26
 
What the ACA Decision Really Means for the Future of Medicare & Medicaid Print E-mail
Written by Paul Gionfriddo   
Monday, 16 July 2012 07:44

Our Health Policy Matters         

A column focusing on federal, state and local health policy  

In the wake of the Supreme Court's decision on the Affordable Care Act, the future of the two biggest government health insurance programs - Medicare and Medicaid - just became much more interesting.

The Affordable Care Act made significant changes to both programs, and they will change the landscape of federally-financed health care in the future.

Most noteworthy, it closed the Medicare prescription drug donut hole. This is no small matter to the 3.6 million people who benefitted in 2011 alone.  Altogether, they saved $2.1 billion in drug costs, an average of over $600 per person, according to the Center for Medicare and Medicaid Services (CMS).

In addition, Medicare recipients are receiving a whole new set of free preventive services, including annual physicals.  In the first five months of 2012, CMS reported that 14.3 million recipients received at least one free preventive service as a result.

But these benefits didn't come without a cost.  And even before the passage of ACA, the Medicare Trust Fund was slowly bleeding out its reserves.

The Medicare Part D Drug Benefit program, enacted in the early 2000s, added about $1,870 - or 15% more - to the average benefit a Medicare beneficiary received in 2011.

In part because of this added benefit, according to the 2012 Report of the Medicare Trust Fund Trustees the Medicare Trust Fund lost $19 billion last year.

So Congress did two things to constrain Medicare costs.  The first was to impose a reduction in physician payment rates by 31% beginning in 2013.  The Affordable Care Act savings assumed that this reduction would be put into effect; however, the "doc fix" forestalled this in 2012, as it has in every year for the last decade.

The second - approved in ACA - was to cap rate increases for Medicare providers in the future. The combination of these two cost saving measures is significant.  Medicare today costs about 3.7% of GDP.  With the cost-saving measures in place, its share of GDP is still expected to grow to 6% by 2040, and to 6.7% by 2085. 

This is pretty high.  Without the cost-saving measures, however, Medicare costs rocket to an almost unsustainable 10.3% of GDP over the next seventy-five years.
 
Can Medicare be fixed?

The answer is yes.  According to the Trustees' report, it would take a Medicare tax increase of 0.67% to individuals, and 0.67% to employers, to guarantee the future of Medicare as we know it for the next 75 years.  In other words, for every hundred dollars in Medicare taxes we currently pay, we would need to add 67 cents more.
 
Is saving Medicare worth those 67 cents to the 80 million of us who will be insured by the program in 2030?

ACA's changes to the Medicaid program were even more significant.
 
Medicaid is an important safety net program not just for elders and lower income people, but for most health providers, too.  Medicaid today makes 60% of all payments to nursing homes, and 37% to community health centers, 35% to public hospitals, 26% to behavioral health providers, and 17% to hospitals overall.

ACA increased the eligibility standard for Medicaid to 133% of poverty - approximately $30,000 in yearly income for a family of four today - beginning in 2014.  It also mandated states to do the expansion, which would add 17 million people to the program by 2016, bringing the total number of Medicaid recipients to 52 million.

However, the court ruled the mandatory Medicaid expansion unconstitutional, leaving it up to the states.
 
Click HERE to read the entire blog post.

Last Updated on Friday, 20 July 2012 08:20
 
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